Rachael Noble

Hospital care and repetition following self-harm: multicentre comparison of self-poisoning and self-injury.

BACKGROUND Quantitative research about self-harm largely deals with self-poisoning, despite the high incidence of self-injury. AIMS We compared patterns of hospital care and repetition associated with self-poisoning and self-injury. METHOD Demographic and clinical data were collected in a multicentre, prospective cohort study, involving 10,498 consecutive episodes of self-harm at six English teaching hospitals. RESULTS Compared with those who self-poisoned, people who cut themselves were more likely to have self-harmed previously and to have received support from mental health services, but they were far less likely to be admitted to the general hospital or receive a psychosocial assessment. Although only 17% of people repeated self-harm during the 18 months of study, survival analysis that takes account of all episodes revealed a repetition rate of 33% in the year following an episode: 47% after episodes of self-cutting and 31% after self-poisoning (P<0.001). Of those who repeated, a third switched method of self-harm. CONCLUSIONS Hospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned. Attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm.

Predicting Change for Individual Psychotherapy Clients on the Basis of their Nearest Neighbors.

This study extended client-focused research by using the nearest neighbor (NN) approach, a client-specific sampling and prediction strategy derived from research on alpine avalanches. Psychotherapy clients (N=203) seen in routine practice settings in the United Kingdom completed a battery of intake measures and then completed symptom intensity ratings before each session. Forecasts of each clients rate of change and session-by-session variability were computed on the basis of that clients NNs (n=10-50 in different comparisons). Alternative forecasts used linear or log-linear slopes and were compared with an alternative prediction strategy. Results showed that the NN approach was superior to the alternative model in predicting rate of change, though the advantage was less clear for predicting variability.

Transforming between Beck Depression Inventory and CORE-OM scores in routine clinical practice.

OBJECTIVES The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) and the Beck Depression Inventory (BDI) are routinely used to assess emotional problems. It would be helpful to be able to compare scores when only one of the measures is available. We investigated the relationship between the measures and produced translation tables. METHODS Level of agreement between CORE-OM and BDI-I was assessed for 2,234 clients who had completed both measures at referral for routine secondary care. Tables for predicting between the measures were constructed using several methods, including non-linear regression and non-parametric smoothing. Results were cross-validated on a separate sample of 326 clients. RESULTS High correlations between the measures were obtained (r=.862 for female clients; r=.855 for male clients). Accuracy in predicting caseness is higher than predicting depression levels. CONCLUSIONS CORE-OM and BDI can be compared in routine clinical settings with acceptable accuracy.

The process of long-term art therapy: a case study combining artwork and clinical outcome

Abstract The authors present process and outcome data collected during the treatment of a client seen for weekly art therapy sessions over 6 years in the UK National Health Service. Routine outcome measures completed before and after therapy with a 3-year follow-up confirmed positive therapy results. The client was part of a research study that required completing an evaluation instrument (Clinical Outcomes in Routine Evaluation Outcome Measure: CORE-OM) before each session. Retrospectively, the significance of the volume of data this produced over 6 years was recognized, and researchers collated numerical data for a single case study. At the same time, the art therapist reviewed her notes from therapy and the artwork produced by the client. Artwork was categorized by the therapist as representing different phases of therapy. After therapy ended, data from the researchers and the therapist were then systematically examined together. This study explores links between progress indicated by the CORE-OM and type of art produced, highlighting issues relating to the process, appropriateness, and cost-effectiveness of long-term therapy.

Controlled Clinical Trial of a Self-Help for Anxiety Intervention for Patients Waiting for Psychological Therapy

This study was a controlled clinical trial in which patients were offered a brief low cost, low intensity self-help intervention while waiting for psychological therapy. A CBT based self-help pack was given to patients with significant anxiety problems and no attempt was made to exclude patients on the basis of severity or co-morbidity. The treatment group received the intervention immediately following assessment and the control group after a delay of 8 weeks so comparisons between the two groups were made over 8 weeks. Although there was some support for the effectiveness of the self help intervention, with a significant time x group interaction for CORE-OM scores, this was not significant with the intention to treat analysis, nor for HADS anxiety and depression scores and the effect size was low. A follow up evaluation suggested some patients attributed significant goal attainment to the intervention. The findings suggest the routine use of self-help interventions in psychological therapies services should be considered although further more adequately powered research is required to identify the type of patients and problems that most benefit, possible adverse effects and the effect on subsequent uptake of and engagement in therapy.

The effect of using NHS number as the unique identifier for patients who self-harm: a multi-centre descriptive study

BackgroundProcessing personal data for research purposes and the requirement of anonymity has been the subject of recent debate. We aimed to determine the proportion of individuals who present to emergency departments with non-fatal suicidal behavior where an NHS number has been successfully traced and to investigate the characteristics of patients associated with non-capture.MethodThis was a descriptive study of people attending after self-harm using allocation of NHS numbers as main outcome measurement. Data from the Multicentre Monitoring of Self-Harm Project from 3 centres in England were used to identify consecutive patients (N = 3000) who were treated in six emergency departments in Oxford, Manchester and Leeds in 2004 and 2005 following self-harm.ResultsNHS number was available between 55–73% of individuals across centres. Characteristics associated with non-recording of NHS number in more than one centre included those from ethnic minority groups (Oxford: chi-squared statistic = 13.6, df = 3, p = 0.004; Manchester: chi-squared statistic = 13.6, df = 3, p ≤0.001) and the homeless or living in a hostel or other institution (Oxford: chi-squared statistic = 40.9, df = 7, p = <0.001; Manchester: chi-squared statistic = 23.5, df = 7, p = 0.001). Individual centre characteristics included being of male gender (Leeds: chi-squared statistic = 4.1, df = 1, p = 0.4), those under 25 years (Oxford: chi-squared statistic = 10.6, df = 2, p = 0.005), not being admitted to general hospital (Leeds: chi-squared statistic = 223.6, df = 1, p ≤0.001) and using self-injury as a method of harm (Leeds: chi-squared statistic = 41.5, df = 2, p ≤0.001).ConclusionBasing research studies on NHS number as the unique identifier, as suggested by the Data Protection Act 1998 and the Patient Information Advisory Group, would exclude some of the most vulnerable groups for further self-harm or suicide. This bias may also affect other research registers.

The importance of comparison in a phenomenological study of clients' experience on an assessment group for group psychotherapy

Using a grounded theory approach, this study explored the experiences of eight clients who attended a group assessment group (GAG) within a UK adult psychotherapy service. The aim of the GAG was to give clients a one off experience of group therapy to enable them to make a more informed decision about the suitability of analytic group therapy. The qualitative analysis revealed comparison to be a key theme for 7 of the 8 clients. Comparison with others was experienced in terms of similarity and dissimilarity of problems and issues and of the behaviour of the group members. These experiences related to issues such as deserving to be there and stigma and this influenced their decisions to opt for group work. Comparisons were also made between the GAG and subsequent group therapy. The issue of social comparison is discussed with reference to previous theory and research and the implications of the study for group therapy and group assessment groups are explored.